Dr Vig aims to become an academic geriatrician and a nationally known expert on quality of life at the end of life. She has made preliminary steps toward this goal by completing a Master's degree in Public Health, and by obtaining funding through a Pfizer/American Geriatrics Society Postdoctoral Fellowship to fund her initial research project. Her research to date has combined her interests in geriatrics, medical ethics, and the end of life. She has used qualitative and quantitative methods to better understand older adults' and terminally ill adults' views of the end of life. During the period of this K23 award, she aims to progress from a semi-independent to an independent investigator by following a program of research and training. Her career development and training will be overseen by Dr Robert Pearlman with additional assistance from Drs Itamar Abrass, and J Randall Curtis. The research and training program will take place at the University of Washington, which has rich resources and personnel to promote Dr Vig's career development. The proposed program will include 1) selective coursework in biostatistics and qualitative methodologies, 2) experience in evaluation of research proposals, and 3) experience in program evaluation. The proposed research aims to promote quality of life at the end of life by investigating the patient and family perspective on the use of advance care planning (ACP) and hospice services. Advance care planning and hospice allow patients to forgo aggressive care at the end of life. ACP identifies preferences that will direct care in the case of decisional incapacity, a common occurrence at the end of life. Hospice services implement patients' care preferences when death in the near future is anticipated. The first project will characterize how advance care planning influences decisions made in "real time" and how proxies respond to the task of surrogate decision-making. The second project will characterize patient and family understandings of hospice and identify the barriers from the patient/family perspective that prevent timely access to hospice services. Study participants will complete interviews containing open ended and closed-ended questions. Both qualitative and quantitative methodologies will be used to analyze participant responses. The long term goal of these two projects is to improve the quality of end-of-life care by promoting advance care planning and access to hospice services to people with life4imiting illness, their families, and loved ones.